John C. Jarrett

Prolonged intrauterine retention of fetal bones after abortion causing infertility

This case study discusses a patient with prolonged intrauterine retention of parts of the fetal skeleton. A 22 year old black woman presented with secondary infertility. After almost 1 year of attempted diagnosis, a hysteroscopy was performed and a white-appearing tubular structure which was similar to the noncopper-bearing portion of an IUD appeared to be embedded in the fundus. Removal was difficult and the removed segments proved to be bone. Results indicated there were bits of fetal bone partially embedded at the fundal portion of the uterus for 6 years after an induced abortion. Curettage yielded several more bone bits; repeat hysteroscopy confirmed that the uterus was empty. The patient have an uneventful postoperative recovery and is being followed up. There appears to be no other previously published report of fetal bones retained for up to 5 years after an abortion by dilatation and curettage. These bones could have contributed to this patients postabortion infection. The value of hysteroscopy was clearly demonstrated in this case. Curettage alone could have missed the bones but hysteroscopy enabled the physicians to visualize the bones and their location. The authors speculate that the presence of the bones acted as a uterine synechia or an IUD and thus prevented pregnancy. It is also possible that the presence of bones near the fundal region elevated endometrial postaglandin F2alpha concentration in that region and rendered her infertile.

Small bowel obstruction following diagnostic laparoscopy.

The occurrence of an incarcerated small bowel hernia through a subumbilical laparoscopic incision site is a rare event. The obstruction occurred 7 weeks after laparoscopy and 1 week after bilateral tuboplasty through a Pfannenstiel incision. Following laparoscopy, the possibility of a bowel obstruction should be entertained in any patient presenting with signs consistent with this diagnosis regardless of the intervening period of time.

Identification of a novel gene set in human cumulus cells predictive of an oocyte's pregnancy potential

OBJECTIVE To identify a gene expression signature in human cumulus cells (CCs) predictive of pregnancy outcome across multiple clinics, taking into account the clinic and patient variations inherent in IVF practice. DESIGN Retrospective analysis of single human cumulus-oocyte complexes with the use of a combined microarray and quantitative reverse-transcription polymerase chain reaction (qRT-PCR) approach. SETTING Multiple private IVF clinics. PATIENT(S) Fifty-eight patients. Samples from 55 patients underwent qRT-PCR analysis, and samples from 27 patients resulted in live birth. INTERVENTION(S) Gene expression analysis for correlation with pregnancy outcome on individual human CCs collected immediately after oocyte retrieval. Pregnancy prediction analysis used leave-one-out cross-validation with weighted voting. MAIN OUTCOME MEASURE(S) Combinatorial expression of 12 genes in 101 samples from 58 patients. RESULT(S) We found a set of 12 genes predictive of pregnancy outcome based on their expression levels in CCs. This pregnancy prediction model had an accuracy of 78%, a sensitivity of 72%, a specificity of 84%, a positive predictive value of 81%, and a negative predictive value of 76%. Receiver operating characteristic analysis found an area under the curve of 0.763 ± 0.079, significantly greater than 0.5 (random chance prediction). CONCLUSION(S) Gene expression analysis in human CCs should be considered in identifying oocytes with a high potential to lead to pregnancy in IVF-ET.

SUCCESS RATES FOLLOWING INTRACYTOPLASMIC SPERM INJECTION ARE IMPROVED BY USING ZIFT VS. IVF FOR EMBRYO TRANSFER

AbstractPurpose: The purpose of this study was to analyze whether the mode of embryo transfer (ZIFT vs IVF) affected the outcome in intracytoplasmic sperm injection (ICSI) cycles. Methods and Results: Eighty-two ICSI cycles (42 ZIFT and 40 IVF) were analyzed. Several variables, including patient age and weight, numbers of mature eggs collected, injected, and fertilized, fertilization rate, number of fertilized eggs obtained per cycle, numbers of zygotes/embryos transferred, clinical pregnancy rate, and implantation rate, were compared. Mean patient age and weight were identical. The mean number of mature eggs collected and injected and fertilization rate were significantly higher in the ZIFT group, however, the mean numbers of zygotes/embryos transferred were identical. The clinical pregnancy and implantation rates in ZIFT cycles (52.3 and 23.2% respectively) were significantly higher than in IVF cycles (17.5 and 9.7%). Conclusions: These data suggest that ZIFT is the more appropriate method for transfer of ICSI-derived embryos.

Adhesion formation and uterine tube healing in the rabbit: a controlled study of the effects of ibuprofen and flurbiprofen

To determine if the prostaglandin synthetase inhibitors ibuprofen and flurbiprofen can suppress postoperative adhesion formation, New Zealand White rabbits that had uterine tubal ligation underwent uterine tube reanastomosis and were given either saline solution (controls), 75 mg of ibuprofen intravenously every 6 hours, or 12.5 mg of flurbiprofen intravenously every 6 hours for 8 doses after operation. Both ibuprofen and flurbiprofen significantly reduced postoperative adhesions (p less than 0.025). With histologic indices of tissue reunion, ibuprofen and flurbiprofen were associated with significantly less scar thickness than controls (p less than 0.001) but did not have any significant effect on mucosal regeneration, foreign body reaction, and muscularis disruption. When all four histologic indices were compared, flurbiprofen but not ibuprofen had a significantly lower score than controls, indicating the greater potency of flurbiprofen over ibuprofen. Our findings show that ibuprofen and flurbiprofen can suppress perioperative and postoperative surgically induced inflammatory response associated with healing and thereby reduce adhesion formation and scar thickness.

Contraceptive practices of female runners.

An examination of the contraceptive practices of female runners indicates that method choice differs from national study samples. Life style and occupational subgroups are rarely reviewed in most national studies, which generally divide their populations according to race and age. 70 female runners responded to a newspaper solicitation and completed questionnaires on the effects of running during pregnancy and contraceptive choice prior to pregnancy. The mean age of the respondents was 30 years and the mean parity was 1.3. The diaphragm was used by 44.3% and all barrier methods combined accounted for 60% of the contraceptive methods chosen. Oral contraceptives (OCs) were used by only 12.8% of the group. The results are similar to those obtained in other studies of female runners which also indicate an increased incidence of diaphragm use and a decrease of OC use compared to the general population. The reasons for this are unclear but a concern for and desire for control over their physical health may be an important factor.

Partial hypopituitarism and hyperprolactinemia: successful induction of ovulation with bromocriptine and human menopausal gonadotropins

The case of a patient who developed partial hypopituitarism (hypogonadotropism and growth hormone deficiency) following transphenoidal removal of a prolactinoma is described. Hypogonadotropism persisted despite restoration of normoprolactinemia with bromocriptine therapy. Successful induction of ovulation with human menopausal gonadotropin (hMG) and bromocriptine suppression of the hyperprolactinemia was carried out, resulting in a pregnancy. The pros and cons of operative and nonoperative management of hyperprolactinemia are discussed.